From the Guidelines
Tadalafil should not be used as a primary treatment for congestive heart failure (CHF), but it may have potential benefits for some patients with CHF under close medical supervision. The Princeton III Consensus recommendations emphasize the importance of cardiovascular risk assessment and management in patients with erectile dysfunction (ED), and suggest that PDE5 inhibitors like tadalafil may have a potential role in the management of hypertension and endothelial dysfunction in patients at risk for cardiovascular disease 1.
Key Considerations
- Tadalafil can cause vasodilation, which may help reduce afterload in heart failure patients, potentially improving cardiac output and exercise capacity.
- However, it can also cause hypotension, which may be dangerous in some heart failure patients, particularly those with low blood pressure or those on other vasodilating medications.
- The typical dose for erectile dysfunction (10-20 mg as needed) is not appropriate for heart failure treatment; instead, lower daily doses (such as 5 mg) might be considered if deemed appropriate by a cardiologist.
Management and Monitoring
- Patients with heart failure should continue their prescribed heart failure medications and lifestyle modifications as directed by their healthcare provider.
- Any consideration of tadalafil for heart failure should involve a thorough discussion of potential risks and benefits, and close monitoring for side effects, particularly hypotension and worsening heart failure symptoms.
- High-risk patients should be referred to a cardiologist for further evaluation and managed with a collaborative approach to primary prevention, with patient follow-up and reassessment recommended 1.
From the Research
Effect of Tadalafil on Congestive Heart Failure (CHF)
- Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, has been studied for its potential effects on congestive heart failure (CHF) in various research papers 2, 3, 4, 5, 6.
- A case report published in 2023 found that low-dose tadalafil improved hemodynamics in a patient with biventricular heart failure, allowing for increased doses of renin-angiotensin-aldosterone system (RAAS) inhibitors 2.
- A study published in 2014 found that tadalafil improved left ventricular diastolic function in patients with resistant hypertension, which could potentially benefit patients with CHF 3.
- Another study published in 2013 discussed the cardiovascular-protective effects of tadalafil, including its ability to improve hemodynamic indexes and elevate endothelial cell-derived nitric oxide levels 4.
- However, a randomized controlled phase 3 study published in 2024 found that tadalafil did not improve outcomes in patients with heart failure with preserved ejection fraction and combined postcapillary and precapillary pulmonary hypertension, and may have potential safety concerns 5.
- A review article published in 2008 discussed the relationship between erectile dysfunction and cardiovascular disease, and highlighted the potential benefits of PDE5 inhibitors, including tadalafil, in improving cardiac output and reducing pulmonary vascular pressure in patients with CHF 6.
Key Findings
- Tadalafil may improve hemodynamics in patients with biventricular heart failure 2.
- Tadalafil may improve left ventricular diastolic function in patients with resistant hypertension 3.
- Tadalafil has cardiovascular-protective effects, including improving hemodynamic indexes and elevating endothelial cell-derived nitric oxide levels 4.
- Tadalafil may not improve outcomes in patients with heart failure with preserved ejection fraction and combined postcapillary and precapillary pulmonary hypertension, and may have potential safety concerns 5.
- PDE5 inhibitors, including tadalafil, may have beneficial effects on cardiac output and pulmonary vascular pressure in patients with CHF 6.